Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery最新文献

The David procedure has been extensively studied as an elective treatment when valve anatomy and function permit valve-sparing aortic root replacement. This approach is particularly beneficial in young patients who also require mitral valve repair and treatment for mitral annular disjunction. This video tutorial provides a step-by-step guide to the David V procedure in a female patient with Marfan syndrome, presenting with an aortic root aneurysm, severe mitral regurgitation and mitral annular disjunction.

We present a 62-year-old female with severe aortic valve regurgitation and a ruptured large sinus of Valsalva aneurysm. The aneurysm was resected in its entirety. A single-leaflet aortic valve reconstruction combined with a left coronary sinus aortic root replacement (hemi-Yacoub procedure) was performed with success.

Concomitant aortic root and pulmonic root aneurysms secondary to giant cell arteritis are extremely rare. We present a case of a patient with giant cell arteritis who underwent concomitant valve-sparing aortic root replacement and valve-sparing pulmonary root replacement along with tricuspid valve repair.

Robotic-assisted thoracic surgery is increasingly recognized as a valuable approach for the most complex of pulmonary resections, offering high-definition 3D visualization, enhanced instrument articulation and tremor-free precision. Compared to open thoracotomy, the robotic platform is associated with reduced peri-operative morbidity, shorter hospital stays and faster post-operative recovery. However, sublobar resections such as segmentectomies remain technically demanding, particularly in the context of anatomical variations, as illustrated in this case. The integration of 3D reconstruction imaging allows for meticulous pre-operative assessment of bronchovascular anatomy, enabling tailored surgical planning and more accurate dissection. Despite these clear advantages, the routine application of 3D virtual modelling in thoracic surgery is still underutilized and remains insufficiently represented in the existing body of evidence. This video tutorial is the third entry in the 'Segmentectomies Made Easy' atlas and demonstrates a robotic left S3 segmentectomy performed for a metastatic pulmonary lesion. Pre-operative 3D imaging revealed distinct anatomical variants, which played a pivotal role in shaping the dissection strategy. The tutorial provides a structured, step-by-step account of the procedure, from port placement to segmental resection and complex anatomical identification, emphasizing how 3D visualization can enhance surgical accuracy, improve intra-operative decision-making and optimize outcomes in robotic segmentectomy.

In minimally invasive direct coronary artery bypass surgery, the integrity of the internal mammary artery graft depends on the minimization of trauma during its harvesting. Moreover, bipolar cauterization of side branches has shown superiority in animal studies. This report highlights the use of bipolar micro forceps in robotic skeletonized internal mammary artery harvesting. Its application offers optimal tissue handling, safe cauterization, minimal thermal spread, and time-efficiency, as instrument exchange is minimized, significantly decreasing harvesting time.

The patient was positioned supine with the right chest slightly elevated. Following induction of general anaesthesia and intubation using an endotracheal tube, connection to the cardiopulmonary bypass was established via the groin vessels under the guidance of transoesophageal echocardiography. Additionally, a venous cannula was inserted through the right internal jugular vein to facilitate bicaval cannulation. The surgery was performed via a 5 cm right mini-thoracotomy at the fourth intercostal space. After soft tissue retraction and pericardial traction sutures, a 3D camera port (Aesculap EinsteinVision, Germany) and a Chitwood clamp for aortic cross-clamping were inserted through separate incisions. Antegrade cold blood cardioplegia was administered via a catheter in the ascending aorta. The surgery involved several steps. For the 1st step, transatrial approach to the mitral valve through Waterston's groove was used. After that transmitral approach to the interventricular septum and submitral structures of the left ventricle was performed. Next step was septal myectomy and secondary chordae resection to the mitral valve. Finally, the anterior mitral valve leaflet reattachment to the annulus was done.

The Berlin Heart EXCOR Adult biventricular assist device (BiVAD) is an approved option for mechanical circulatory support in patients experiencing end-stage biventricular heart failure. In this video tutorial we demonstrate a clinical case of BiVAD EXCOR implantation in an adult.

Robotic cardiac surgery continues to evolve, offering patients a less invasive alternative to traditional median sternotomy, even for complex procedures. This report presents a case of robotic totally endoscopic aortic valve replacement using a rapid deployment valve combined with mitral valve repair, demonstrating the feasibility and safety of this approach.

Re-operation following previous congenital heart repair can be challenging. We present a 38-year-old female with a history of partial atrioventricular septal defect repair in infancy who developed severe mitral regurgitation due to a cleft anterior mitral leaflet. Given her anatomy and prior sternotomy, we performed a redo minimally invasive endoscopic mitral valve repair via right anterolateral minithoracotomy access. We meticulously closed the cleft using precise suture placement to restore leaflet integrity and function and performed an annuloplasty to reinforce the annulus and optimize leaflet coaptation. The minimally invasive approach minimized surgical trauma, while endoscopic visualization allowed for a precise and effective repair. This case highlights the feasibility of this approach in patients with complex congenital heart disease, offering a viable alternative to sternotomy with potential benefits for both short- and long-term outcomes.

Robotic-assisted thoracic surgery has become an increasingly valuable technique for performing complex lung resections, offering high-definition visualization, refined instrument control and tremor-free precision. When compared to open thoracotomy, robotic approaches are linked to lower perioperative morbidity, shorter hospitalizations and quicker recovery times. Nonetheless, sublobar resections such as segmentectomy remain technically and anatomically challenging procedures, particularly in the presence of anatomical anomalies, as demonstrated in this case involving the right S3 segment. Combined three-dimensional reconstruction imaging enables detailed preoperative mapping of pulmonary anatomy, allowing surgeons to visualize bronchovascular structures with greater clarity and tailor dissection plans accordingly. Despite its proven benefits, the routine use of three-dimensional virtual imaging in thoracic surgery remains vastly underutilized and under-represented in the current literature. This video tutorial forms part of the Segmentectomies Made Easy atlas and presents a robotic right S3 segmentectomy for an incidental small pulmonary lesion. Preoperative three-dimensional reconstruction revealed a unique anatomical variation, which proved critical in guiding the dissection strategy. The tutorial offers a comprehensive, step-by-step overview of the operative process-from port configuration to anatomical isolation and resection-highlighting the value of three-dimensional imaging in improving surgical precision, intraoperative decision making and overall outcomes in robotic segmental lung surgery.